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Alert: Codes are moving out of LCDs and into Billing and Coding Articles!
In response to a provision of the 21st Century Cures Act, the Centers for Medicare & Medicaid Services (CMS) revised chapter 13 of the Medicare Program Integrity Manual (PIM). This chapter describes the local coverage determinations (LCD) process. One significant change is the relocation of codes (ICD-10-CM, CPT/HCPCS, Bill Type, and Revenue) from LCDs and into local coverage Articles. The MACs were instructed to begin relocating codes process began in January 2019 and is expected to continue through January 2020.
During this transition period, codes may be found in either an LCD or an Article. However, when a particular LCD has its codes removed, the Medicare Administrative Contractor (MAC) will create a Billing and Coding Article which will contain the codes. The LCD and the Billing and Coding Article are companion documents. They will be related to each other, and MCD users can see the relationship and access the related document by navigating to the "Related Local Coverage Documents" section in either the LCD or Article.
More information on the changes made to PIM Chapter 13 and the LCD process can be found here: https://www.cms.gov/newsroom/fact-sheets/summary-significant-changes-medicare-program-integrity-manual-chapter-13-local-coverage
The Medicare Coverage Database (MCD) contains all National Coverage Determinations
(NCDs) and Local Coverage Determinations (LCDs), local articles, and proposed
NCD decisions. The database also includes several other types of National Coverage
policy related documents, including National Coverage Analyses (NCAs), Coding Analyses
for Labs (CALs), Medicare Evidence Development & Coverage Advisory Committee
(MEDCAC) proceedings, and Medicare coverage guidance documents.
The MCD offers multiple ways to locate and view data:
The MCD is intended for use by Medicare contractors, providers, and other healthcare
industry professionals. People with Medicare, family members, and caregivers should
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Document Update Schedule
Local Coverage Documents (LCDs and Articles) move from the CMS Medicare Coverage Database
(MCD) to the MCD Archive in real-time, according to the following schedule:
Please visit the
MCD Archive Site
to view archived documents.
The MCD includes a comment tool that the public can use to submit comments on National
Coverage documents open for public comment.
Currently, there are no National Coverage documents open for public comment.